I was recently interviewed about my approach to chronic fatigue syndrome by Christine Coen who is a Registered Dietitian, Functional Nutritionist, & Fitness Specialist with over 10 years’ experience training clients to thrive mentally and physically through movement, nutrition, and mindset shifts.
What is Chronic Fatigue?
Imagine that a simple errand exhausts you for days. You can barely get out of bed to take a shower or fix a simple meal. For people struggling with chronic fatigue syndrome (CFS), this is their everyday reality. No matter how much rest they get, they just can’t seem to shake the extreme fatigue they feel.
Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis, is extreme tiredness which doesn’t improve with rest. The fatigue can affect one’s entire life and prevents them from the simplest day to day activities. Unfortunately, Chronic Fatigue Syndrome (CFS) often impacts highly successful, driven people who are used to performing at the top of their game. Being chronically tired can be both physically and emotionally devastating for someone who is used to being highly productive.
Since the complex layers of this condition are not well understood by Western medicine, it is commonly brushed off by doctors and patients alike. In fact, it is estimated that 90% of people with Chronic Fatigue Syndrome (CFS) are not properly diagnosed.
Chronic Fatigue Syndrome: Diagnosis & Common symptoms
The primary symptom of CFS is unrelenting fatigue. There are currently no lab tests that directly diagnose CFS. Diagnosis is based on the evaluation of symptoms and medical history. Diagnostic criteria include:
And at least one of the following:
Some of the more common symptoms can include:
Enlarged lymph nodes
Joint or muscle aches
Symptoms range for six months, with moderate, substantial or severe symptoms for at least half of the time
This non-specific diagnostic criteria and vague symptoms leave a lot of room for interpretation by medical professionals. Sometimes these symptoms are treated individually and are seen as unrelated to each other. Many times patients are given sleep medications or sent to see a psychiatrist before they are properly diagnosed. If you are having symptoms of CFS, you should see a medical professional that is specialized in chronic fatigue syndrome to determine the right diagnosis.
In addition to the profound fatigue experienced, other serious symptoms or conditions often accompany CFS, such as:
Fatigue 12 to 48 hours after exercise that can last for days to weeks
Trouble remembering, learning new things, concentrating, or decision making
Dizziness or fainting when standing up
Rapid heart rate with activity
Alternating between sweating too much and not sweating at all
Feeling burned out
Depression or shifting moods
Joint aches and muscle pains
Anxiety and depression
Irritable Bowel Syndrome (IBS)
Major depressive disorder (MDD)
Chronic Fatigue Syndrome (CFS) occurs more commonly in women. The cause of this condition is currently unknown but may include environmental or genetic factors.
A good starting point to discovering if you may be suffering from CFS is to write down any health concerns you have had in the past six months.
You may find it necessary to start a health journal and document any consistent signs and symptoms or unexplained issues. Being able to look back on your journal may help you see patterns and hidden problems that you didn’t see while living through those days.
Also, reviewing your past health history and family history will be valuable and will help your functional medicine practitioner if you seek further help.
Potential Contributing Causes
There are several risk factors and underlying health conditions that can contribute to the development of CFS. Each individual underlying cause may completely change the necessary tests required and the treatment. For this reason, the entire picture needs to be evaluated to determine the right approach in each case.
In functional medicine, we approach the body as a whole, rather than concentrating on just one area. Just like peeling back the layers of an onion, we investigate each patient’s unique situation to reveal the unique root causes behind their illness.
As a part of the diagnosis, we often create a timeline based on the patient’s medical history to document the progression of CFS and identify contributing factors. After a thorough interview, physical exam, medical history, and relevant laboratory tests, we usually have a much better understanding of the potential underlying causes. This allows us to develop an appropriate treatment plan tailored to each person’s unique situation.
1. Inflammation and Leaky Gut
Inflammation is a leading cause of many illnesses, and CFS is definitely one of them.
Inflammation can come from many sources including diet, food allergies or sensitivities, infections, medications, heavy metals and environmental pollutants, mold, previous surgeries, and tooth infections.
One of the most significant sources of inflammation associated with Chronic Fatigue Syndrome (CFS), is gut inflammation. A leaky gut (impaired intestinal permeability), irritable bowel syndrome (IBS), or an imbalance of the gut microbiome (bacteria in your gut) activates the immune system leading to multiple symptoms associated with CFS.
These include; flu-like illnesses, abdominal pain, diarrhea or constipation, anxiety and depression, brain fog, and extreme fatigue.
2. Infections and Autoimmunity
Infections can go undetected for many years. Underlying infections include viral, bacterial, fungal, Epstein-Barr virus (EBV), herpes simplex, parvovirus, Q fever, and Lyme disease. These infections can result in fever, fatigue, muscle pains, breathing issues, digestive problems, and energy levels that fluctuate in a cycle. Infections can be difficult to track down and may not always appear as an “abnormal” finding on your lab work.
While there are tests that can certainly detect underlying infections, it’s important to take into account the person as a whole, not ignoring symptoms if a lab test comes back as normal. Several studies have pointed to evidence that CFS may be autoimmune driven and associated with metabolic disturbances including a history of frequent infections.
3. Mitochondrial Dysfunction and Autoimmunity
Mitochondria are in every cell of the human body and are famous for being the “powerhouse of the cell”, meaning they produce most of the body’s energy.
However, newer research is showing that the mitochondria do much more than just produce energy. The mitochondria is heavily involved in many body processes and when it is not working well or is dysfunctional, it will lead to oxidative stress, free radical formation, and inflammation. Mitochondrial dysfunction shares many of the same symptoms of CFS.
4. HPA Axis Imbalance
The Hypothalamic-Pituitary-Adrenal (HPA) axis helps your body adapt to stress. Stress is not always a bad thing as we need stress in order for our body to adapt and survive.
When we are in a stressful situation our body anticipates that we will eventually come out of it and go back into a state of rest and relaxation. However, many people are in a state of constant stress at home, work, in relationships, and finances among many others.
Long-term stress creates dysfunction in the HPA axis and leads to low cortisol levels, or Adrenal Fatigue, which is consistently associated with CFS.
Treatment for Chronic Fatigue Syndrome (CFS)
Since CFS has different underlying causes, the treatment is often tailored to the individual. With that said, there are a few general guidelines we often recommend for most CFS patients:
Diet & eating plan that focuses on whole foods, healthy sources of clean, grass fed animal protein along with plenty of fresh fruits and vegetables. The diet generally eliminates high sugar foods and processed, refined foods that can spike blood sugar making fatigue worse.
Supplements may vary depending on nutrient testing and symptoms present. Common deficiencies that may contribute to fatigue include B12, vitamin D, and iron. Mitochondrial support with CoQ10, Acetyl-L-carnitine, D-ribose, and B-complex can also help to optimize energy production.
Lifestyle. Although you might be physically exhausted, staying at home in bed all day can worsen your symptoms. Tailored physical activity, spending time in nature, and social interactions may help increase your energy, mood and emotional wellness. Actively managing stress is also a critical part of the path to feeling better.
Final Thoughts If you are struggling with unrelenting fatigue that is preventing you from living your best life, don’t hesitate to reach out. CFS is not a life sentence, and with a personalized treatment plan, you can start to feel better.
I am committed to helping you get your energy and health back, book a consultation.
Dr. Tim Jackson, DPT, CNS(c)